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Capt. Calum Ramm at the Antarctica Logistics and Expedition base camp on Union Glacier. The tents in the back were the team’s lodging.Credit Callum Ramm

Calum Ramm, a captain in the Marine Corps, has run many marathons in his day, but last week he set out on a far bigger challenge: running seven marathons on seven continents in just seven days as part of the World Marathon Challenge. Starting off deep in Antarctica on Jan. 23, he went on to complete marathons in Chile, Miami, Madrid, Morocco and Dubai before the finale in Sydney, Australia, on Friday. Only 15 athletes took part; those who finished ran 183.4 miles through snow, mountains, tropical heat and city streets.

Captain Ramm, from Lansing, Mich., is running to raise money for a charity, the Semper Fi Fund. and is a member of the official Marine Corps running team. Here are some of his thoughts about his experience:

Running in Antarctica was actually a lot easier than I thought. It was a four-lap course, and if I closed my eyes it was almost as if I was running in Michigan during a long winter in my high school days. I only had a base layer and jacket on, plus the normal hat / gloves / balaclava, and still overheated at times. Because the sky was the same hue as the snow, it was difficult to see anything more than white — and beyond it, the outline of mountains. A thin slice of blue sky off the horizon was the only thing that kept me from losing all orientation.

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Captain Ramm finishing the marathon in Punta Arenas, Chile, with a time of 3:13:18. This was taken less than 24 hours after he had run the marathon in Antarctica, finishing with a time of 3:31:43.Credit Richard Donovan/World Marathon Challenge

Chile was way easier, but the wind was brutal. Almost had me moving backwards at some points. I went out really slow, but dropped some serious splits on the last eight miles. Felt really good upon finishing, almost better than Antarctica. The footing was obviously better so that helped.

In Dubai I hit my wall. I thought I may not finish, at least not running. Pounding out so many miles on pavement had beat my feet up pretty bad and I had some serious shin splints — so bad that my whole leg started to swell. I could hardly put weight on it before the race started. By mile eight I was hurting pretty bad. At that point, I decided to shed my sneakers and run barefoot, hoping to reduce the swelling and open up the blood flow. I normally do one training run a week barefoot in grass, and that came in handy at this moment. I crossed the line in under four hours, which was a huge relief. But my race in Australia felt in jeopardy.

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Captain Ramm running barefoot in Dubai.Credit Courtesy of Calum Ramm

I knew I had to run Sydney in shoes because it was 13 laps on brick. Plus it was at night and along the beach — so who knew what I might step on. Walking to the start line, the wind was out of control. Not ideal conditions for a bummed leg. But like I had done in Dubai and Morocco, I thought about all the individuals cheering me on and knew I had to just gut it out. I linked up with the other Marine and we pushed through a mile at a time to finish in 3:38 for the final race.

It was bittersweet crossing that line. I was happy I didn’t have to wake up and throw the running shoes back on. But this incredible life experience was coming to a close. Running has always been so much more than just a hobby for me. It has been a venue to vent my frustrations, clear my head and help sort out life’s challenges. And in this event, the many, many miles spent with nothing but the pavement and my thoughts meant something more: a chance to help troops and veterans in need. Thanks for the support.

Since coming back from Afghanistan in 2008, the hard-hit Second Battalion, Seventh Marine Regiment has struggled to adjust. The battalion, known as the 2/7, lost 20 men in war. In the years since, it has lost 13 more to suicide. The battalion now has a suicide rate 14 times that for all Americans.

The New York Times asked Dr. Charles Engel, of the RAND Corporation, and two Marines who served with the battalion in Afghanistan, Arthur Karell and Keith Branch, to answer readers’ questions about the devastating effects of combat and the high suicide rate among veterans. The conversation took place on Facebook in October, moderated by Dave Philipps, a reporter for The Times who covers veterans’ affairs. Here are some of the questions and answers, which have been condensed and edited.

Q. Why were the mental health concerns of the battalion not identified following deployment? What can be done to better identify service members who are struggling?

Arthur Karell: The process for identifying mental health concerns consisted of one post-deployment health assessment (a questionnaire), along with two weeks of downtime leave after getting back to the States. Then the battalion immediately enters a training cycle for the next deployment. The overwhelming emphasis is on constant tactical training — longer-term considerations got crowded out. I have heard that this is now starting to change, and I hope that is actually the case. Allowing Marines and other service members more time to spend together as a cohesive unit after a combat deployment would go a long way to better identifying service members who are struggling. Finally, that there is zero information-sharing between the Department of Defense and the Veterans Administration makes it impossible for health providers or volunteer organizations to have access to information that could provide indications of possible problems. Privacy is an issue, but service members should at least have the option to allow their D.O.D. service records to inform V.A. health providers.

Keith Branch: Ideally, if someone scored as “high risk” on the post-deployment assessment, he or she would be referred to on-base mental health services. From my memory, there were only a handful of service members who utilized these services — I was one of them. However, my stint in therapy lasted less than a month. First, there is an extremely prevalent negative stigma associated with seeking mental health services, especially in the combat arms occupations where weakness is not tolerated. I hope things have changed since 2009. Second, the mental health services on base had long waiting periods and the solution was to prescribe medication. I know more than a few Marines who became addicts while seeking mental health services. From my experience, many Marines do not show signs of mental health problems until they separate from the service. I think being surrounded by the people who served in combat with you provides a sense of security. However, that security is lost when service members separate and return home.

Q.Are multiple combat deployments a contributing factor to suicide?

Dave Philipps: The data suggest there is little or no added suicide risk associated with multiple deployments, but those studies have been unable to address the amount of combat seen. Second, no study has looked at this question after active duty. We simply don’t know. Anecdotally, nine of 13 members of the 2/7 who killed themselves did multiple tours. And I think it is important to note the quick succession of these tours, with less than a year between.

Q.Is the pain experienced by veterans who return from combat rooted primarily in the events of the past or in their outlook for the future?

K.B.: For myself and many other veterans from Second Battalion, Seventh Marines, the pain that is rooted in the past gives rise to an irrational outlook for the future. That is to say, an emotional trigger in the present can provoke the anxiety experienced in a past event and cause a veteran to have an irrational, grim view of the future. Being the tip of the spear for your country instills the highest amount of purpose one could seek to achieve in a lifetime, at least from a veteran’s perspective. The veterans who soon establish a purpose, whether through a career, volunteer work or some other activity, and have a supportive environment, tend to become happy and successful. On the other hand, if a purpose is not found during the critical period of military to civilian transition, veterans will suspend themselves in time. This can lead to many devastating behaviors such as addiction, isolation, and the list goes on. There are other important secondary factors such as the health of intimate relationships, financial stability and treatment from society.

A.K.: The events of the past inform the outlook for the future. When the events of the past repeatedly trigger an anguish that doesn’t abate, it may cause a veteran to question what kind of future they have in store. I’ve heard of post-combat stress described as a response to deep moral trauma, as war is just about the most intense and certainly the largest-scale moral trauma humans inflict on one another. For veterans, post-military activities, pursuits and/or careers that involve or embody a shared purpose, go a long way toward recovery from that moral trauma.

Q.What role do guns have in veterans’ suicides?

D.P.: In the 2/7, nine of the 13 Marines who killed themselves used guns. I spoke to three more who put a gun to their head and pulled the trigger but did not die, and several more who had contemplated suicide with a gun. It appears to be a very big risk factor to have a gun in the house. The V.A. has recognized this, but has been careful in how it presents advice (recommending storing weapons voluntarily with a friend) because doctors don’t want veterans to avoid treatment out of fear they will lose their guns.

Dr. Charles Engel: Six of 10 gun-related deaths are suicides, and about half of all suicides are gun-related. Most suicides occur on impulse, and the availability of a gun makes it all too easy for a person experiencing suicidal thoughts to act on that impulse. Some have speculated that perhaps one reason that suicide is elevated among military personnel and veterans is their experience with guns. Exchanging hostile fire in battle, especially the experience of killing, may represent an important psychological threshold. The tragic psychological familiarity that comes with crossing that threshold may well increase the likelihood of subsequent self-inflicted injury in someone already thinking about suicide.

Q.I know so many veterans who are prescribed all sorts of prescriptions off label and leave the V.A. with a plastic bag full of drugs. Do we know whether these drugs have an effect on the suicide rate?

C.E.: Unfortunately, determining whether there is a causal link between multiple medications and suicide is extremely difficult. The bag of pills observation is all too common in my clinical experience and never a good thing. It’s essential that any person taking prescription psychoactive medication only does so while under the close care of an appropriately credentialed and skilled clinician. Leftover medications and old pill bottles should be disposed of completely to prevent confusion. Less is often more when it comes to the benefits of medications — more medications leads to increased chance of side effects, drug-drug interactions, and mistakes — both by patients when taking them and clinicians when prescribing them. It’s always best to have a primary care clinician who leads the treatment team who can review and oversee your entire treatment regimen.

Q.The public generally uses post-traumatic stress disorder, or PTSD, as a catchall label for the psychological effects of combat. Are there distinct treatments for other issues — guilt, depression, loss of interest in life — that seem to fall outside the clinical definition of PTSD?

C.E.: PTSD, as used among mental health professionals, is a clearly defined constellation of persistent symptoms that is serious enough and lasts long enough to result in significant problems for the person suffering from them. The traumatic psychological events that can result in PTSD go well beyond military-related trauma and can include, for example, accidents, natural disasters, child abuse, and physical and sexual assault. Similarly, the downstream effects of PTSD can be broad and include a range of mental and physical health effects that fall outside the technical definition of the disorder. The most common of these include depression, anxiety, alcohol and drug misuse, chronic pain and sometimes poorly explained but disabling physical symptoms. There are evidence-based treatments for these problems. Those treatments can sometimes overlap with the treatments for PTSD, but combining treatments to target each person’s unique circumstances and health profile is essential.

Q.Why isn’t more being done to try and understand the connection between drug and alcohol use and PTSD?

D.P.: In my reporting on the 2/7 battalion, I found alcohol was a huge factor in a number of deaths. Many of the guys were treating their anxiety and sleep problems with alcohol, which generally created more problems (eroding their support system of loved ones, for example.) At least five of the 13 Marines I wrote about shot themselves while drunk.

Q.Why doesn’t the V.A. track suicides by unit and command? Wouldn’t that tell us a lot about conditions inside those units and who might be in danger?

D.P.: For generations, the V.A. has for the most part attempted to look at all veterans the same regardless of rank or service. This was done altruistically in an attempt to provide veterans the same standard of care. Now, however, health care increasingly uses Big Data to do risk prediction. So all the factors of military service may be extremely helpful in predicting who, for example, is most likely to kill themselves, and what patterns or clusters are emerging. A system that combined military and V.A. data could conceivably spot a combat unit with a high level of mental health issues and target it for outreach. It could also inform policy makers about who is at risk and when, so resources could be designed to meet actual needs. However, the military and V.A. still have a bureaucratic gulf between them that neither is likely bridge alone.

Q. The figure coming from the V.A.: “22 veteran suicides every day” is said to be misleading. Why?

D.P.: The statistic was offered by the V.A. in one of their recent suicide reports. While it seems to be a staggering number, it is actually misleading because it doesn’t tell us the rate as compared to the larger population, so we don’t know if the rate is elevated, and what the trend is. A couple more helpful numbers: The suicide rate for all veterans who served between 2001 and 2009 is about 30 deaths per 100,000 — more than twice the national average. And the risk for them is greatest in the first three years after separating from the military.

Q. With the increased involvement of women in the military, how do their suicide numbers compare with those of men?

C.E. In the military as in the general population, rates of suicide are consistently higher in men than women. However, research suggests that currently deployed women may have higher rates of suicide than military women who have never deployed. In contrast, currently deployed men show little if any increased suicide risk compared to military men who have never deployed. An Army study found that the risk of suicide among currently deployed women was about three times that of nondeployed women. Even so, the risk of suicide among currently deployed men was still almost twice as high as for currently deployed women.

D.P.: In general, women have much lower rates of suicide than men, in part because men tend to use firearms more often. But a recent study found women who are veterans are drastically more likely to commit suicide than civilian women. This may be because women who are veterans use firearms more often.

As suicide attempts go, mine was of the halfhearted variety. In fact, some might even argue that it was no attempt at all. The police arrived at my Austin home following a fight I’d had in the driveway with my friend Bill, who’s also a veteran. Bill had been called over to the house by my then girlfriend because she was worried about the way I was acting.

I was wired on a cocktail of Adderall and Trazodone, and had a few drinks the night before as well. When the police arrived the following morning, a man and a woman, I asked the woman if her pistol was loaded.

“Of course it is. Why would you ask a thing like that?”

“Because I want you to shoot me in the head.”

To this day, I’m not sure why I said that. In retrospect I think it was less about wanting to die and more about expressing to another human being that I was in pain. But they were police officers, and a solicitation for suicide-by-cop, however unconvincing, was something they took very seriously.

“Right,” the male officer interjected. “We’re gonna have to bring you to the hospital.”

A minor struggle ensued outside, to the entertainment of my neighbors who observed the scene from a comfortable distance. I learned later from Bill and my now ex-girlfriend that the police entered my home and grabbed all the pharmacy bottles they could find (which numbered in the teens) and brought them to the hospital so the emergency room staff would know what I was on. They even stuck a catheter up my urethra.

They held me in observation for a day and a half, until I could get a friend to pick me up and drive me to the Austin Veterans Affairs Outpatient Clinic to speak to a mental health specialist. She wanted me to come in every week through the summer, but I told her I had plans to study abroad in France, so she made me promise to check back in when I returned or she would have me brought in. I came for a follow-up at the end of the summer, just because I didn’t want the police to come back to my house. I had no interest in engaging with the V.A. mental health specialists. They were way too quick to prescribe medication, and drugs were something I was trying to get away from.

In Afghanistan, I served as a Navy corpsman (combat medic). I never fired a weapon in combat, but I did treat gunshot and fragmentation wounds. The heat, the sweat, the smell of filth, the fear and danger, the long hours on the road, the mutual distrust of the local populace, the belief that the next time we left the wire would be the time we’d get hit, the four or five instances of absolute terror spread out over a yearlong deployment – these were the things that gave me pause and caused me to desire and seek numbness.

I had also suffered an injury in a car accident a year before I got out of the Navy. The accident was caused by an adverse reaction to a sleep medication, which led me to sleepwalk to my car, get in and drive. As a result, there was no shortage of pain medications in my possession.

For a person in free fall, it’s difficult to see the bottom. Certain programs of recovery describe a “white light” experience; a moment of divine clarity in which the user finally gets it. This was not true for me. I’d tried in vain to get clean for the better part of four years following my return from Afghanistan. Eventually, the effort paid off, and I got better. There was no white light.

It requires great discipline to get sober and stay sober. But sobriety also requires community. It’s necessary to be able to say to another addict or alcoholic, “I have this problem, too; I’m like you. If I can beat this, you can beat this.”

Veterans with drinking and drug problems experience an additional layer of isolation. The feeling that we can’t relate to non-veteran addicts and alcoholics is pervasive among the veterans in recovery whom I know personally. But I’ve come to learn that addiction is indiscriminate, and we have more in common with civilian addicts than we’re perhaps inclined to believe.

We can’t talk sensibly about veteran suicide without first talking seriously about veteran addiction. Drug and alcohol abuse are major indicators of suicide. This is especially true in the veterans community. There’s no doubt that we’re facing a mental health crisis. Our mental health professionals in the V.A. and in the civilian world have a tendency to over prescribe mood stabilizers, tranquilizers and anti-depressants. These drugs all have legitimate uses, and many patients absolutely need them. But if our focus is on using drugs to treat post-traumatic stress disorder or other combat related problems, we might, in fact, be making things worse. It’s possible that I’m wrong; I speak entirely from my own experience. But for me, I could not come down off the ledge until the drugs and alcohol were off the table.

Brandon Caro is the author of the debut novel, Old Silk Road (Post Hill Press, Oct. 13, 2015). He was a Navy corpsman (combat medic) and adviser to the Afghan National Army in Afghanistan from 2006-7. He holds a bachelor’s degree in liberal arts from Texas State University, and is currently pursuing a master’s degree in fiction writing from The New School in New York City.

My wedding day was the first best day of my life. I could not have ordered a more perfect day if I had had a menu of choices in front of me. The marriage to my best friend was what I was really looking forward to. I wanted to settle down and start a family and that’s what we did. Our ideal world was lost on Sept. 6th, 2003. My husband, a member of the National Guard, was activated two days before our second son was born. Two weeks later he went to Iraq on what ended up being almost a year-and-a-half journey where he fought for his country and I fought to maintain our home.

For years after his deployment, I watched him struggle. I scratched and clawed to get him resources that were difficult to coordinate. I begged for tests; I fought to be the voice he did not have; I fought to be heard. He would tell his health-care providers one thing, but I would witness another. They experimented with a string of antipsychotic drugs, leaving me to deal with the potential dangerous side effects without any heads up. I put up with way more than I should have, but I held tight to our “for better or worse” vows and the unbending belief that if the tables were turned he would do the same for me. He would take care of me, right? After years of working through the system, we finally got the diagnoses of traumatic brain injury (TBI) on top of post-traumatic stress disorder. His care team fought hard to make sure his needs were met. We even started a nonprofit geared toward helping veterans and their families.

As time went by, two more babies came. My husband had moments of happiness, but generally was deep in depression, struggling with severe migraines and issues with TBI. Suffice it to say that certain lines were crossed, and I felt I could no longer remain married to him. I asked him to leave and, on Friday, our divorce became final. He let me go without hesitation. For him, there was apparently no reason to fight to keep me. I don’t want to come across as a bitter ex-wife. But I am angry that our happy life, our loving relationship was destroyed in combat.

After all I had been through with him, I was now faced with another reality. Once you are divorced from a veteran, resources such as counseling go away. I even asked for help to tell him to leave the house but was told no, even though I worried for my safety. I was told their services were to provide a safe place for the veteran.

After all the hard work, devotion and advocacy, I felt demoted, unloved.

Veterans need to learn how to reintegrate into their families and how to take care of those families again; how to trust their spouses again. As a caregiver, you are put in a position of authority over your spouse, doling out daily “what to do’s,” managing the finances. What toll does that take on a marriage that is supposed to be built on equal partnership? At the same time, the caregiver feels forgotten, berated and belittled because his or her complaints pale in comparison to the pain, emotional or otherwise, of the veteran. What happens when we get sick? Surely we do not want to be told, as some spouses are, “It’s not like you’re dying! I know guys whose legs have been blown off.”

As it turns out, I am lucky. I have a job with benefits. But there are so many other military spouses who gave up careers and education to take care of their wounded partners, only to see their marriages disintegrate and find themselves emotionally devastated and without money. At that point, they no longer have access to the multitude of resources available to veterans and their families, such as Department of Veterans Affairs individual or group counseling or educational benefits. Many women who were dependent on their spouses’ incomes also find themselves financially in shambles after divorce. Such women, unless they were fiduciaries of their husbands’ veterans benefits, might have no access to that money during, or after, marriage.

So, now I am asking myself, what are those spouses supposed to do when they too serve their country and work so hard to help veterans and their families, but are not eligible for their services anymore because they are not family anymore. Many of us feel angry, like we were left holding the empty bag. I really wanted what my parents had, that 50 years together, growing old together thing. I wanted to be worth fighting for, too.

Jackie McMichael is from Durham, N.C., where she currently works as a professional development manager in the software industry. She was married for 15 years to an officer in the North Carolina National Guard and currently works in her spare time with veteran spouses and organizations.

Last year, my co-worker Emma called to let me know she was driving away from Walter Reed for the very last time. She had just resigned. She thought she would feel sadness or have pangs of remorse. But instead she had just felt relieved. It was over.

Emma and I worked together as physical therapists at Walter Reed Army Medical Center and then later its reincarnation, Walter Reed National Military Medical Center, for nine years.

When we were first hired in 2005, Walter Reed was so busy with incoming casualties there was a rumor that they would erect M*A*S*H tents on the front lawn of the hospital to handle the overflow. That never happened. Instead, when the wards tasked with treating the wounded filled up, the new incoming soldiers (mostly men) went to Ward 67 – the gynecology unit.

In the amputee section, where Emma and I worked, we could tell you exactly how things were going for our ground troops in Iraq and Afghanistan. When the troop surges happened in 2007 and 2009, there were so many new amputees coming in that, in one week, I saw three of my co-workers cry. But the wounded kept coming. And somehow, by 2011, we were treating an average of 150 multi-limb amputees a day.

Emma confessed on the phone that she hadn’t felt right for months and had gone to her doctor. She said that after the doctor left the room, she read her chart. She knew she wasn’t super healthy, but it was altogether different to read in black and white that she didn’t exercise, drank frequently and had a stressful job.

I was only half listening, because I had the phone balanced between my shoulder and ear as I tried to pry the cap off a bottle of beer. Walter Reed hadn’t been that healthy for me, either.

You would think that in the amputee clinic you would get used to seeing amputations, but there was always something new. In the beginning, below knee amputations and below elbow amputations were the norm. But as the wars progressed and the bombs and terrain got deadlier, we saw amputations above the knee and above the elbow. And later amputations at the groin. Those progressed to include partial pelvic amputations.

As the amputations moved up the body one night I had a dream that we saw our first body amputee: a patient whose torso and neck had been neatly severed at the head.

How did my co-workers in my dream react when that single head came in? Like we always did: we cheered for him. And we said what we always said, “Look at you! Look how great you are doing!”

The young soldier who was now just a head smiled and agreed with us, relief visibly flooding his face. “I am doing O.K.,” he said, grateful to hear from somebody, anybody, that he was all right.

That’s how it was in our clinic. No matter how badly you were hurt we always thought you were doing great.

In 2009 our first surviving quadruple amputee was pushed into our rehab gym. It was the 100th anniversary of the hospital and outside on the front lawn a big party was going on. As our new patient entered, my co-workers leapt to their feet and let out a uniform “whoop!” As we clapped and cheered, our new patient waved the short stump of his right arm and flashed the room a brave grin.

“He is going to be an ambulator,” my supervisor said at that moment. Because in our clinic you were always going to walk again, no matter the wound.

You would think that working in a clinic that saw so much destruction would be depressing, but life in our clinic was always happy and, above all, funny. The patients wore T-shirts with slogans like “I had a Blast in Afghanistan” and “Marine – Some Assembly Required.” And they made fun of each other for having “paper cuts” instead of amputations.

Scattered among the patients were staff members who would animatedly discuss the latest infomercial we had seen on late night T.V. – prompting one of my colleagues to actually order a powder blue Snuggie (a blanket with sleeves) to wear to work.

When a patient had a birthday, he or she would proudly wear the Snuggie and a special birthday-cake-shaped hat while we stood around their wheelchair and sang loudly, and cheered (of course). We’d present a birthday cake – even though you weren’t supposed to have food in the physical therapy clinic. And then everyone would eat a slice of gooey cake. An hour later, that same patient would receive another birthday cake across the gym in occupational therapy.

Every day we brought in bewildered new amputees to join our playground — on big hospital chairs that you could flatten out and roll like an operating room stretcher. We’d tie their IV poles to the back of the chair and hang their wound vacuum machines, nerve blocks, catheter bags and various drains off the armrests, and then haphazardly push them down the long corridors to the rehab gym. Their family members would trail behind us, mute with shock.

To fill in the silence of the voyage we would prattle happily along, pointing out all the great places the young veteran could visit in the hospital: the DFAC (dining facility), the barber shop, the PX (military store) — once he or she was well enough to get into a wheelchair. The highlight of our “tour” was passionately describing the weekly cafeteria specials to our captive and stunned audience.

But before an eyebrow could be raised, the tour was interrupted with a sharp warning: “Bump!” And the patient would brace him or herself for the incredible jolt of pain as their stretcher rolled over the smallest crack in the floor. And we, the staff, did our best to buffer it for them.
Adele Levine worked as a physical therapist at Walter Reed from 2005 until 2014, and is now in private practice in Silver Spring, Md. Her writing has appeared in The Washington Post, The Washingtonian and Psychology Today, and she is the author of “Run, Don’t Walk: The Curious and Chaotic Life of a Physical Therapist Inside Walter Reed Army Medical Center.” Follow her on Twitter: @PTAdele.

No millennial worth his iPhone remembers life before social media. While previous generations’ warfighters wrote letters or phoned home over spotty connections, Marines today can post on Instagram photos of themselves sitting atop cans of ammunition. In 2010, the photojournalist Teru Kuwayama and his collaborators embedded in Afghanistan to start a Facebook page for the First Battalion, Eighth Marines to communicate with loved ones. Far from resulting in just another live-stream of minutiae, their Basetrack project became a way for deployed troops to maintain relationships with their families. The resulting trove of photos and videos provide ample fodder for “Basetrack Live” — the onstage story of one corporal’s deployment and homecoming, and the effects on his family.

For both the battalion and a nation’s artists, self-reflection occurred stunningly quickly through the use of social media. Anne Hamburger, executive producer of En Garde Arts, the company behind “Basetrack Live,” said she felt it was important to document the human side of going to war, without sensationalizing the experience.

“The issues are so complex” when an ordinary person deploys, Ms. Hamburger said. Her biggest challenge for the production, which is showing at the Harvey Theater, Brooklyn Academy of Music, and will be going on a national tour, was paring down the “incredible wealth of material,” she said.

Ms. Hamburger reached out through Facebook, gathering more than 100 respondents and conducting three dozen interviews to cull images and video for the project. Every word in “Basetrack Live” is taken from interviews with Marines or members of their families.

This citizen journalism captures the truth of troops’ feelings during deployment, including graffiti about pornography, and profane, funny rules for standing watch and cleaning toilets. The images chosen for the production reflect the Marines’ brotherhood, including an impressive assortment of tattoos. Because of the authentic, emotion-rich material, the Marines are painted neither as heroes nor victims.

The plot delves into the relationship between Cpl. A. J. Czubai and his wife, Melissa. Corporal Czubai is played by Tyler La Marr, a former Marine Corps sergeant and the founder of the Society of Artistic Veterans. Mr. La Marr is quick to point out that his experiences as a signals intelligence analyst in Iraq were distinctly different from Corporal Czubai’s infantry deployments to Afghanistan.

Initially, Mr. La Marr was worried that Corporal Czubai would be angry “because a pogue is telling his story!” he said in an interview, referring to military slang for “a person other than grunt,” or infantryman. But talking with Corporal Czubai helped, and the actor acknowledged that his boot camp training, with its ethos of “every Marine a rifleman,” gave him a head start on the role.

Melissa Czubai, played by Ashley Bloom, wrestles with a lack of control over situations engineered by the Marine Corps, including A. J.’s inability to be present for the birth of their daughter because of his predeployment training. “Basetrack Live” also includes the perspectives of other wives and girlfriends, and that of one Marine’s mother, to illustrate the war’s toll on families.

The web of relationships also highlights the desire of civilians to hear from Marines in close-to-real-time, bringing to light the space between deployed and home environments, and the nuanced human drama that it spans. Social media’s rapid communications can be a mixed blessing, as worries on the home front can be transmitted to deployed troops, and electrons can convey flaring tempers in both directions. Of greatest concern were erroneous reports of casualties on Facebook, which only served to accelerate the rumor mill among wives and girlfriends. In Corporal Czubai’s case, his wife learned of his best friend’s death before he did, even though he was in a neighboring company in Afghanistan.

The speed of modern life, reflected in social media, can also be jarring to nerves accustomed to a contained, mission-focused environment. After being wounded in a firefight, Corporal Czubai is sent back to the United States, while his comrades carry on in Afghanistan. This loss of his unit’s camaraderie disorients him. Overwhelmed by paranoia and guilt, he drinks, buys an array of weapons, threatens suicide and struggles with a strained marriage. He eventually accepts counseling from the Department of Veterans Affairs, but the play avoids a saccharine ending.

Now out of the Marine Corps and studying for a bachelor’s degree in civil engineering at the University of Texas at Arlington, Corporal Czubai has seen several performances of “BaseTrack Live” and found the adaptation of his story “captivating.”

Ms. Hamburger said that she intended for the show to walk a fine line: conveying emotion without being overly sentimental about the participants’ experiences. The music — original compositions by Edward Bilous, Michelle DiBucci and Greg Kalember — blends a variety of styles: the rush of initial deployment to Afghanistan mixes powerful hip-hop with tribal tunes, while the disorientation of combat is illustrated by crashing rock and bright lights.

Using authentic videos and images, “Basetrack Live” offers a realistic perspective on relationships when one partner has gone to war, and how, after the long road home, social media can be a useful tool to build a sense of community. The wives and girlfriends of those serving in the First Battalion, Eighth Marines, who found each other via the project’s Facebook page, offered one another support, including tactics for waking sleeping Marines with hair-trigger reactions. And many of the Marines, themselves, stayed in touch with one another long after returning home, and were trading bear hugs at Tuesday night’s performance.

In future wars, the speed of communication will only get faster. Short of hologramming into combat, service members’ loved ones cannot get much closer than connecting daily via social media. Emotionally, this can blur the lines between battlefield and home front. “Basetrack Live” ably captures this juxtaposition and its aftermath, affording viewers a fresh look at war’s realities and at the challenges of coming home.
“Basetrack Live” was adapted by Jason Grote in collaboration with Seth Bockley and Anne Hamburger. It is playing at the Harvey Theater, Brooklyn Academy of Music, (651 Fulton St, Brooklyn) through Saturday.

Teresa Fazio was a Marine Corps officer from 2002 to 2006 and deployed to Iraq. She lives and works in New York, and is writing a memoir about a relationship during deployment.

Joseph Gotesman, right, and other VetConnect workers made rounds in the Hunts Point section of the Bronx in May.Credit Ozier Muhammad/The New York Times

Under the tracks of a northbound 5 train, Joseph Gotesman pulled a sandwich from a plastic bag and approached a man sitting near a jumble of boxes. His query was crisp and succinct: “Excuse me, sir. Are you a veteran?”

Mr. Gotesman, 22, leads VetConnect, a Bronx-based organization devised to combat homelessness among veterans. Since it started work in January, the small group has made contact with dozens of veterans living on the streets in and around the Bronx. VetConnect has helped five veterans get permanent housing, including one who needed it to get much-needed surgery, and has worked with others to find employment.

“Many of our partners started out as small, neighborhood-focused organizations. We value every effort, however small, to reach out to a homeless man or woman and connect them to services,” Chris Miller, the spokesman. “It makes a difference.”

The strength of VetConnect, said Mr. Gotesman, is its grass-roots nature. “We’re local,” he said. “You can’t get more local than community members reaching out to their own. And as we grow, it will be community members reaching out to their own as well. You won’t see me at a VetConnect excursion in an L.A. or a Boston community excursion.”

And that is exactly where the organization is heading. In the last few months, VetConnect has begun the process of putting together teams in other states where homelessness among veterans is high, such as California and Texas. In September, VetConnect was awarded a $5,000 grant from the Arnold P. Gold Foundation, which will assist the organization in, among other things, expanding, conducting research and distributing materials.

But Mr. Gotesman, who is in his second year of medical school at Einstein College of Medicine in the Bronx, has found that the issues that homeless veterans face are complex and often require continuous effort to resolve.

“Helping a veteran is not a quick, simple feat,” he said in an email. “It takes time and relationship and trust building.”

Still, fostering relationships with veterans living on the streets can be difficult. Mr. Gotesman says that many of the veterans he has met are wary of seeking help from the Department of Veterans Affairs.

“Many do not believe the change is possible,” Mr. Gotesman explained. “After years or decades on the streets, begging for handouts from passers-by, it almost seems too good to be true.”

Joseph Mangione, 56, was begging for money under the Brooklyn Bridge when he met Mr. Gotesman last December. “It was snowing,” Mr. Mangione recalled in a phone interview. “I was holding a cardboard sign that said ‘homeless veteran.’ He pulled over and offered me help.”

Mr. Gotesman checked on Mr. Mangione every two weeks after their initial encounter. Meanwhile, he and other volunteers called the local V.A. hospital and began the process of verifying Mr. Mangione’s service record and his eligibility for benefits. With help from VetConnect and Section 8 vouchers from the United States Department of Housing and Urban Development, Mr. Mangione was able to move into his own apartment in the Bronx just three months after he met Mr. Gotesman. He recently was granted a license for street vending, allowing him to earn an income and begin to sustain his newfound life.

Mr. Mangione, who served as an infantryman in the Army during the Persian Gulf war of 1991, said he avoided going into shelters when he became homeless.

“They want to throw you in these shelters with drug addicts and alcoholics,” he said. “A soldier doesn’t want to live around that.”

He was also critical of the Department of Veterans Affairs. “They wanted me to jump through so many hoops,” he said.

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Joseph Mangione, who served as an infantryman in the Army during the Persian Gulf war of 1991, in his apartment in the Bronx.Credit Courtesy of Joseph Gotesman

Mr. Gotesman said VetConnect’s goal for veterans was not “to ‘give them a fish,’ it’s to ‘teach them to fish.’ That is, to motivate them to a change and then provide them the necessary connections and resources to achieve their success.”

Recently, Mr. Gotesman helped a veteran named Lawyer Anderson get surgery that had been delayed because he was in and out of shelters, where he often had to sleep in a chair when beds were full. Mr. Gotesman said the Department of Veterans Affairs would not operate on Mr. Anderson’s service-connected injuries until he was in a stable home. After months of trying, VetConnect was able to get him permanent housing and the surgery he required.

Dr. Michael J. Reichgott, who served as an officer in the Army Medical Corps during the Vietnam War, is a professor of internal medicine at Einstein and Mr. Gotesman’s faculty adviser. Dr. Reichgott believes that VetConnect’s small size could allow it to be more personal than larger veterans groups, and called Mr. Gotesman’s efforts “a commendable effort at community service and social advocacy.”

Questions remain about whether such small organizations can address a population of homeless veterans that, according to some estimates, makes up a quarter of the homeless in New York City. But for veterans like Mr. Mangione, VetConnect is a clear answer to a complex problem.

“There should be more like it,” he said. “It’s a shame there’s not.”
Jacob W. Sotak served in the United States Army Reserve for 10 years, including a tour in Afghanistan. He graduated from Dartmouth College and now works as a news assistant at The New York Times. Follow him on Twitter: @JWSotak

These days most NATO forces in Afghanistan rarely, if ever, leave the secured perimeters of their bases. While safer, life on base produces a complicated proximity to the realities of war — we’re both close and far away. At Bagram Airfield north of Kabul, the line between life and death is often clearest in the largest American hospital in the country, Craig Joint Theater Hospital.

The Air Force-led hospital’s primary mission is to treat injured or ill NATO personnel, and despite decreased volume of battle injuries due to the drawdown of troops, the facility remains busy. But now, it’s mostly a steady flow of Afghan trauma and humanitarian patients punctuated by sporadic coalition casualties, such as the wounded from the attack that killed Army Maj. Gen. Harold Greene in August.

Sometimes the contrast between hope and despair, between smooth recoveries and catastrophic battle injuries, comes into focus within minutes.

July 22 was supposed to be the last day in Afghanistan for Air Force Lt. Col. Jason Williams, and he wanted an easy morning to pack, tell friends goodbye and perform a final check-up on a special patient. But a suicide bomber in Kabul changed those plans. Instead, the 38-year-old cardiothoracic surgeon was in an operating room scrambling to save six gravely injured Nepalese security contractors.

More than a dozen doctors, nurses and technicians attended to one man who spent five hours in surgery. Maj. Jon Forbes, a neurosurgeon, worked on a severe brain injury while Colonel Williams and a trauma surgeon, Maj. Jason Pasley, tried to save the man’s arm.

“We’re on our last unit of B. I’m going to activate the walking blood bank,” the anesthesiologist, Maj. Scott Jensen, said as he set a cooler with the last of the hospital’s B-positive next to a pile of empty blood bags.

“Jon, do you think this guy’s survivable?” asked Major Pasley while suturing a hole in the man’s radial artery.

The answer came in a series of dire descriptions of the damage. The man’s middle cerebral artery had been shredded and the left hemisphere of his brain was functionally dead. That would leave him paralyzed on one side of his body and unable to speak or understand language.

“O.K.,” was all Major Pasley said in reply.

Colonel Williams’ camo-patterned Crocs made footprints in the blood pooling on the floor as he and Major Pasley bandaged the man’s arm. Major Forbes continued his quiet work on the man’s brain. Wisps of smoke rose from his cauterizer. The hiss of his suction seemed amplified against the heart monitor beeps and an iPod playing Blake Shelton’s “Boys ‘Round Here.”

A few minutes later, in sweat-drenched green scrubs, Colonel Williams flung open the operating room door and stepped toward the locker room shaking his head.

“That poor guy’s probably going to die,” he said while changing scrubs. “Busy day. Let’s go see the little girl.”

Down the hall, in the hospital’s waiting area — a fluorescent lit, white-tiled room lined with American flags and images of troops who died in the facility — 12-year-old Zuhal and her father, Ahmad, waited to see Colonel Williams. They were the only civilians in the room, and their soft conversation was largely drowned out by the chatter of troops with machine guns and a television tuned to the Armed Forces Network.

A month earlier, the colonel removed a lobe of Zuhal’s lung that had been strangled by a plum-sized cyst. Colonel Williams, a native of Fayetteville, Ga., said the growth was likely the result of a parasite or possibly a congenital problem that put Zuhal at risk for life-threatening chronic infections that could prevent her from developing normally.

Zuhal’s path to treatment took more than a year, but the surgery went well, taking just two hours.

She spent a week and a half recovering at the hospital. Several Afghan security forces healing from amputations and gunshot wounds occupied the neighboring beds, and as the only child in the hospital at the time, she garnered a lot of attention from the staff.

Zuhal and her father smiled when Colonel Williams entered the small exam room. A World War II “Rosie the Riveter” poster with the words “We Can Do It!” hung above her, the riveter’s blue shirt mirroring her own bright blue shirt and eyes.

“So, I’m very happy with how well you’re recovering. You’ve done a great job since surgery,” Colonel Williams said. “This should never come back and should never be a problem again.”

“I’m very happy that we brought her here and you were here,” Ahmad said to the colonel. “She was lucky that you took care of her.”

Zuhal had just one question: “What can I eat?”

“Whatever you want,” the colonel replied.

“I have five kids, and my oldest daughter is your age, and I’m going home tomorrow to see them,” Colonel Williams continued. “You remind me of my daughter.”

As the father and daughter departed, a linguist gave Zuhal some Girl Scout cookies and a juice box. But Colonel Williams’ work was not done: He donated a pint of his B-positive blood for the man he’d just operated on, joking with the lab technician and looking away as the needle went in.

“At some point we’re going to have to leave, and our humanitarian mission is not going to be as robust, or it won’t exist at all,” he said in the operating room lounge while cleaning the dried blood from his Crocs. “When we leave, either some other organization is going to have to come in and take over the humanitarian role, or these folks aren’t going to be cared for as well. There’s a huge medical need here, and there will continue to be for many years to come.”

“I feel like we’ve done some good things here,” said Colonel Williams, who deployed from Travis Air Force Base in California. But, he added, “I’m ready to go home to my family.”

The wounded contractor died that night. The plane carrying his body to his home country left just before Colonel Williams’ flight out of Afghanistan.

Colonel Williams is home now coaching his son’s football team and riding the California highways on a Harley-Davidson that he custom-ordered while at Bagram. Zuhal started seventh grade this week.

Air Force Maj. Brandon Lingle is currently deployed as a public affairs officer at Bagram Airfield, Afghanistan. He has previously served in Iraq and Afghanistan as a public affairs officer. His nonfiction was noted in “The Best American Essays 2010″ and again in the 2013 volume, and he is an editor of “War, Literature & the Arts,” published by the United States Air Force Academy. You can follow him on Twitter.

The views expressed here are those of the author and do not reflect the official policy or position of NATO, the United States government, the Department of Defense or the Department of the Air Force.

“In the Army there are those who walk the walk, and those who just talk the talk.” My drill sergeant at Fort Knox said this to me more than 30 years ago. What he was implying was that there are jobs for soldiers, and jobs for people who just joined the Army for the college plan or to get some skills training.

I had a couple walking-the-walk jobs when I was a young soldier. But for most of my career, the last 17 years of it, I was a military intelligence guy — a case officer — someone who tried to recruit other people to commit espionage; people think of us as spies not warriors. Probably no one ever joined the Army dreaming of being a case officer. Not walking the walk.

And for half of my career, I was a reservist; people think of us as serving one weekend a month and two weeks during the summer. Not walking the walk. While I was in the reserve my civilian job was as a Foreign Service officer. Certainly not walking the walk.

In many cases, my not-walking-the-walk job consisted of going to far away places in the midst of an uprising or insurgency; coming to understand the situation, the parties, their grievances and wants; then writing home about what I had learned. I wrote crisp dry accounts of messy horrible acts of cruelty on long deployments in places like Rwanda, Kosovo, Afghanistan, Iraq, and Sudan — places I thought of as existing along the ragged edge of what my friends and family at home might consider the civilized world.

But writing those crisp dry accounts was not enough for me. Fifteen years ago, in another century, I sat down at a small desk in a rented house in Pristina, Kosovo, and wrote these words, “Yellow. Their skin was yellow.”

Writing my essay, “Yellow,” was my attempt to write the remainders, the things I remembered about the war that did not make it into the official government record. I wrote about the look on an old man’s face as he sat, wounded, in an airless room surrounded by women and children who had also been wounded in a Serbian mortar attack on their village. I wrote about being unsure whether a burned body found in a locked building was that of a child or of a dog. I wrote about a Serb thug holding his pistol against my temple while he yelled how he was going to rape my interpreter and then kill us both.

I didn’t know it at the time, but what I was really writing about was how I developed PTSD. It actually took me several years to figure that out. Years during which I continued to deploy to war zones, weakening myself and feeding the PTSD. A few years after I wrote “Yellow,” I drove out into the desert with a pistol and a couple of beers ready to kill myself.

Luckily, I was interrupted. I came home and got medical treatment. Some of which worked and some of which did not really help. Writing seemed to help, so I kept at it. In time, I had a book. It’s called “Seriously Not All Right: Five Wars in Ten Years.”

A couple of weeks ago, one of the editors of “At War,” asked me to write something about the book, why I wrote it, and what I learned from the process.

Why I wrote the book is simple: I wrote it because that is how I got control of my life and overcame the traumatic memories of five wars in ten years.

Why I published it is a better story, though. While I was writing about the lives I saw destroyed in five wars over 10 years, I looked a little closer to home and started writing about the stigma in the military and in the civilian world, too, of asking for help for PTSD. I wrote about how ridiculous it is that we compartmentalize mental health care from other health care—it is all just health care, after all.

But I was just talking the talk and that is not good enough. It’s analogous to slapping one of those “I support the troops” yellow ribbon magnets on my SUV while I’m on my way to the mall. If I was going to complain so bitterly about the stigma of asking for help, and do so with any authority or integrity, I had to say it out loud. I had to walk the walk.

So I went public with my story. I admitted I had PTSD. I admitted I had come close to suicide. I did so in the hope that someone else might feel safe to do the same.

Once I had come out, I was surprised that most people just sort of shrugged and moved on. A few close friends and colleagues said, “Oh, I never knew.” But in general, there was no trauma about coming out. I don’t really know what all I had expected, but I expected something different. I kind of thought I might get a human stain like that mark on Gorbachev’s head. Maybe I’d be forced to wear a big “L” for loony on my jacket. But no, not so much.

I’ve been out on book tour for a few weeks, off and on, reading and taking questions, sitting for interviews, answering lots of emailed interview questions. My publisher and publicist decided to spread out the tour over a period of months. They were doing me a favor. I can’t tell this story every day for days on end. It’s still hard to talk about taking a pistol in my hand out in the desert ready to kill myself. But every time I tell it I hope someone listening grows a little stronger, a little more willing to stand up and ask for help. Every time they do, they are walking the walk.

Ron Capps is the founder and director of the Veterans Writing Project, a nonprofit that provides no-cost writing workshops for veterans and their families. He served for 25 years in the Army and Army Reserve and is a retired Foreign Service officer. Mr. Capp’s memoir, “Seriously Not All Right: Five Wars in Ten Years,” was published in May 2014 by Schaffner Press.

Anthony and Ivonne Thompson at the bar where Anthony proposed in November 2006.Credit

For Ivonne Thompson, 36, pulling her husband from his wheelchair to bathe him is a way to find time for their marriage. “It is the only intimacy we have left,” she says.

Her husband, Anthony Thompson, 32, survived an explosion of an improvised explosive device, or I.E.D., while he was serving as a Navy corpsman in Iraq. He was left with a diffuse axonal injury — a severe form of traumatic brain injury — and is paralyzed, unable to communicate verbally or physically.

The care Ms. Thompson provides has become an “everyday kind of routine,” she says. After she takes their 6-year-old son, Anthony Jr., to school, she sets to Anthony Sr.’s daily care: range-of-motion exercises for his arms and legs, chest percussions for his breathing. When he has appointments, she drives him to the Veterans Affairs hospital. When there are questions about his care, she discusses options with his doctors.

“After all that,” Ms. Thompson says, “I become the wife.”

The faces of military caregivers — the spouses, the loved ones, the family members and best friends who care for the wounded survivors of war — have long been just out of view, out-of-focus entries on the gray page of veterans’ issues. But a study conducted by the RAND Corporation in conjunction with the Elizabeth Dole Foundation, released in March, has brought into sharp relief the reality of the 5.5 million military caregivers nationwide, one-fifth of whom provide care to veterans of the wars in Iraq and Afghanistan.

Over all, caregivers today are younger than those of previous generations, have fewer support networks and are at a much higher risk for depression and suicide.

For people like Ms. Thompson, caregiving is a full-time commitment to ensuring quality of life for veterans who need help bathing, feeding and administering medications. For others, supporting their loved ones is less hands-on, but no less challenging.

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Natalie Tarte with her husband, Chris Tarte, at a medical facility in November 2011.Credit

Natalie Tarte’s focus is maintaining a stable home environment for her husband, Chris Tarte, and their three young children. Mr. Tarte lost his right foot in an I.E.D. attack in Afghanistan. When doctors said his left leg, which was also mangled in the explosion, could be salvaged, the Tartes were hopeful. But after more than a dozen surgeries and nearly a year in a specialized halo cast called a Taylor Spatial Frame, doctors say the chance of saving the leg is low.

Mr. Tarte also has post-traumatic stress disorder and a form of traumatic brain injury that induces seizures. He has problems with his memory. He sometimes becomes disoriented and frustrated.

According to the RAND Corporation study, caregivers of post-9/11 veterans provide care for emotional and behavioral challenges more often than caregivers from previous wars did, and are four times more likely than non-caregivers to battle depression.

“Chris’s outbursts can be hurtful,” said Ms. Tarte, who has been placed on antidepressants. “It’s hard being married to someone that you basically don’t know. Sometimes there is just a feeling of hopelessness.”

One of the study’s more alarming findings was that more than 37 percent of post-9/11 caregivers reported difficulties because of uncertainty about their loved ones’ conditions and the treatments they were receiving. That number was twice that of pre-9/11 caregivers.

According to Rajeev Ramchand, the study’s co-leader and a senior behavioral scientist at RAND, many military caregivers have no formal support network. “There is a particular need for programs that focus on the younger caregivers who aid the newest veterans,” Mr. Ramchand said.

Emery Popoloski, 27, is one of those young caregivers, providing care for her husband, Charlie Popoloski, 29, who has debilitating seizures and severe post-traumatic stress from a rocket attack he survived while on his first tour to Iraq. The seizures, though often short, prevent Mr. Popoloski from performing involved tasks such as cooking or driving, and make supervision necessary.

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Charlie and Emery Popoloski were reunited at Logan Airport in Boston in January 2009, after eight months apart.Credit

“I feel like you’re a parent watching a kid at a playground,” Ms. Popoloski says of her husband. “You let them go play, but you’re always watching.”

Ms. Popoloski quit her job in September to stay at home with her husband and their two daughters: Caitlin, 3, and Elizabeth, 4 months. But as her husband’s sole caregiver, she has concerns about the future.

“What would happen if I died?” she asked. “What would happen to my kids if something happened to me? What would happen to my husband’s care?”

In 2010, Congress passed the Caregivers and Veterans Omnibus Health Services Act, allowing the Veterans Affairs Department to offer financial support and other services to military caregivers. The support, which includes a monthly stipend, mental health services and counseling, and access to health insurance, is available to those caring for veterans suffering from serious injuries — including traumatic brain injury, psychological trauma and other mental disorders — incurred in the line of duty on or after Sept. 11, 2001.

Though the RAND study is largely an overview of contemporary military caregivers, it raises tough questions about the future of veterans’ care and the health and wellbeing of those yoked with administering it. These are questions that — according to former Senator Elizabeth Dole, Republican of North Carolina, whose foundation commissioned the study — point to the future and confirm that military caregiving is an “urgent societal crisis.”

The report offers several recommendations, including creating programs to foster caregiving skills and approaches and conducting research into caregiving and caregivers to help ensure continued attention to their needs.

For many caregivers, a brighter future is all they can hope for.

“You need to keep moving forward,” Ms. Popoloski says. “You’re going to die if you stay in the same place.”

Jacob W. Sotak served in the United States Army Reserve for 10 years, including a tour in Afghanistan. He graduated from Dartmouth College and now works as a news assistant at The New York Times. Follow him on Twitter: @JWSotak

It is 2014, and to America the war in Afghanistan is over. President Obama’s draw-down year is upon us, and as quickly as 2013 ended when the ball dropped, it seems, so did the nation’s memory of its longest running war.

But while the country may have forgotten, and only the dead have seen the end of it, for the wounded the war never ends.

Reading the article, I couldn’t help but think of my friend Jessie Fletcher, who had deployed twice to Afghanistan and then found himself fighting once more, as a double amputee, to reclaim a life of normalcy.

His tale of resiliency is the story of many veterans. And as the years pass, his triumphs and struggles, and those of his comrades-in-arms, will perhaps come to define that sliver of millennials who took the road less traveled.

The road to war.

***

I was in the library when I found out Jessie had been blown up.

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Jessie Fletcher preparing for patrol in May 2010 in Marja, Afghanistan.Credit Lakota 4.

It was the fall of 2011, my first two months of college after leaving the Marines in January of that year. My uniforms had been folded and put in containers that might not see the light of day for years. I had resorted to hard drives, thousands of megabytes of photos, to recall a life so different from my current one as a student that it seemed like a dream.

I was almost ready to be a student, ready to stop calling the cafeteria a chow hall and to let my hair grow long and unkempt.

But Jessie Fletcher changed all that.

I had met him in 2009, a wide-eyed junior Marine who wore a leather jacket, channeled The Fonz from “Happy Days” and talked sometimes a little too softly for an infantryman.

“Fletcher has been hit, double amputee, critical right now, next few hours vital.”

On Oct. 17, 2011, he was three days away from his 23rd birthday when his legs were blown from his body on a dusty, windswept hill in Helmand Province, Afghanistan.

***

Jessie, a Marine corporal from Watertown, N.Y., with dark features and shocks of black hair, was the assistant leader of an eight-man scout/sniper team — a unit that prided itself as being “the eyes and ears” of the infantry battalion it called home.

In October 2011 Jessie’s team was deployed to Sangin, Afghanistan, and in direct support of the First Battalion of the Sixth Marine Regiment, while the battalion conducted one of the last major American-led operations of the war.

Sangin became infamous in the spring of 2010 when the Third Battalion of the Fifth Marine Regiment suffered the highest casualty rate of any unit to operate in Afghanistan since the start of the war in 2001.

In 2011 the district had barely calmed down. Thousands of improvised explosive devices were still embedded in canals and roadways, making counter-insurgency operations in population centers tedious and bloody. Taliban fighters would use the devices to initiate ambushes, maiming Marines and then attacking those who funneled into the kill zone to retrieve their wounded buddies.

That Oct. 17, Jessie’s team had been ordered to keep watch over a hill that would allow it to observe friendly patrols and convoys in the valley below.

“We didn’t want to go up there,” Jessie said. “We knew they had I.E.D.’s planted all over that hill, but the battalion insisted.”

His team slipped out in the predawn darkness, and in the hours that followed, the team — call sign Jäger 2 — moved methodically onto a ridge that would give it a commanding view of the valley.

Jessie, armed with a carbine and a semiautomatic sniper rifle named Victoria, after Victoria’s Secret, ushered his Marines into position to maximize their visibility.

He was checking on the rear security of his team when he stepped on a 15-pound charge of homemade explosives.

“We couldn’t see anything, and we could only hear a little,” said Donald Carter, the team’s corpsman, or medic. “It took us a minute to figure out it was Jess that was hit.”

Jessie was conscious, bloody and confused, at the bottom of a shallow blast crater. His eardrums shattered, he calmly looked at Carter and asked, “Am I ever going to be able to play guitar again?”

The blast had taken both of his legs above the knee. He also lost fingers from both hands when the synthetic grip of his rifle blew apart, sending shards of black plastic into his hands and forearms.

Carter jumped in the crater and started working on him, placing tourniquets on both legs and arms to stanch the bleeding while keeping up a gentle banter to make sure he did not lose consciousness.

“I kept him awake the whole time, asking him every stupid question I could think of,” Carter said.

A Black Hawk medical helicopter had been denied permission to enter the airspace over Fletcher’s team because it lacked an armed escort for protection. But after five minutes of purgatory the pilot disobeyed orders and landed anyway. The rotor wash kicked up the loose Afghan dust and pelted Jessie’s wounds with debris as Carter huddled over him. Jessie was pulled into the helicopter, which ascended, banked to the north and sped toward Camp Bastion at more than 150 miles per hour.

As the rest of the team members left the hill, they found eight more mines.

Jessie arrived at Walter Reed National Military Medical Center in Bethesda, Md., later that October as copper-colored leaves blew through the chilled streets.

It was late on a Friday when I drove to see him arrive from Landstuhl, Germany. He was sitting up and smiling when they unloaded the ambulance, his stumps connected to tubes that drained the fluid and blood as his body worked overtime to repair the damage. His hands were bandaged as well, boxing gloves of gauze wrapped from his fingers to his forearms.

Yet his face had been untouched. In the chaos of the explosion it escaped the flying steel that cut through every appendage. And so there was Jessie, hopped-up on morphine and flirting with I.C.U. nurses as they wheeled him in and locked his bed in place.

A room away, a lance corporal from another unit lay in a coma while his family slept in the waiting room. No voices there, just the steady, robotic inhale and exhale of the Marine’s ventilator, masked by Jessie’s nervous laughter.

***

Flash forward almost two years. Jessie is wearing his dress blues over black prosthetic legs, and Donald Carter, the man who saved his life, is watching as he slips a wedding band onto Emily Ball’s ring finger.

It is Nov. 16, 2013, and Jessie is getting married in the Childress Vineyards outside Winston-Salem, N.C.

Emily met Jessie in 2010 at the Marine Corps Ball in nearby Greenville, a blind date coordinated by a close friend.

When she went to the hospital after Jessie had been hurt they hadn’t been dating even a year, but she slept on the pullout couch next to his bed every night, waking up every 15 minutes when the doctors switched on the halogen lights to check Jessie’s vital signs and give him his medications.

She watched as he walked for the first time again, and held his head as he came off his painkillers.

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Jessie Fletcher, second from left, at his wedding last November.Credit SteveDavisPhotoVideo

Emily even moved jobs to join a law firm in Washington while Jessie recovered, eventually becoming his live-in caregiver when Jessie was finally released from the hospital.

The wedding was a reunion of sorts of Jessie’s Marine Corps brothers, and that night those bonds were celebrated alongside his matrimony.

There were two Robs, three Mikes, a smattering of Matts, and so on. All had worked with Jessie in some capacity, and all had watched as he healed during two long years at Walter Reed.

We drank in honor of Jessie, and we drank because we had united for a celebration of survival and not another death.

Joe, a good old boy from deep Mississippi, kissed me on the cheek and immediately made me hug his 3-year-old son.

The last time I had seen Joe’s son, Noah, was when he was a sonogram in an envelope that had traveled 7,000 miles to a combat outpost in some godforsaken village in Afghanistan.

Now I held Noah close and whispered to him how big of a clown his father was, and how I looked forward to telling him the unabridged version of his dad’s exploits one day.

Matt, an old light-machine gunner in my team, now attended the University of New Hampshire, and in between sips of wine lamented about his final exams.

Staring at Matt saunter across the room, I remembered staring at him in 2010 after he had been shot in the chest by a sniper, and we wondered if he would make it.

We took pictures together, and men who once would have been clad in body armor and rifles now wore teal ties and juggled children in their arms.

Jessie ambled around, gyrating on dual carbon-fiber prosthetics, smiling and introducing us to his actual brothers as his other brothers.

The Purple Heart on his chest glowed in the dimly lit atrium, and Matt shouted across the room, asking what exactly he got it for. We all laughed, because ignoring Jessie’s injuries would have been an insult.

His amputations were just as much a part of him now as was his hometown and his first kiss. He had embraced them, and it was time we did, too.

And so Jessie walked into that brisk November night a married man, with his best friends on either side of him. Much had changed since that day in Sangin, but the kid from Watertown had not.

He rolled down the window, waved with his three-fingered left hand, and sped away.

Thomas Gibbons-Neff (@TMGNeff) served as an infantryman with the First Battalion, Sixth Marine Regiment from 2007 to 2011 and participated in two deployments to Afghanistan. He is a columnist at the blog War on the Rocks and the executive editor at Georgetown University’s newspaper, The Hoya.

The secretary of the Department of Veterans Affairs, Eric K. Shinseki, last week, outlined President Obama’s 2015 budget for the department before hearings of the House and Senate veterans affairs committees, calling for total spending of $163.9 billion, a 6.5 percent increase from last year. The plan asks Congress to allocate $68.4 billion for discretionary spending, a 3 percent increase from last year, which is largely used for health care, and $95.6 billion for mandatory programs such as disability compensation and pensions for veterans.

Mr. Shinseki said he wants the spending to address three major goals: the continued expansion of health care access and other benefits for both new and aging veterans, ending homelessness among veterans and clearing the extensive backlog of disability claims.

Clearing the backlog – defined as disability claims that have taken 125 days or longer to process – remains a benchmark that the department struggles to reach. Though the backlog has decreased in the last year, to just under 370,000 claims, veterans groups continue to criticize the department for its inability to eliminate the delays. And the work continues to grow. According Mr. Shinseki, 1.5 million new compensation and pension claims are expected to be filed in 2015, an increase of 20 percent over 2014.

Spending directed at ending homelessness, one of Mr. Shinseki’s personal priorities, will increase by 14 percent, to $1.6 billion. In particular, spending for the National Call Center for Homeless Veterans, a hotline developed in 2010 as part of Mr. Shinseki’s plan to end homelessness by the end of 2015, would increase by 45 percent to $5.6 million.

Mr. Shinseki, who was appointed by President Obama in 2009, drew fire at the Senate hearing on two of the department’s toughest issues: providing adequate care to veterans who suffer from traumatic brain injury and post-traumatic stress, and expanding access to services for veterans in rural areas.

Senator Bernie Sanders, an Independent from Vermont and the chairman of the Senate committee, probed Mr. Shinseki and his under secretary for health, Dr. Robert Petzel, on the department’s ability to respond to the fast-growing need for mental health services.

“We are dealing now with hundreds of thousands of men and women who have come home from Iraq and Afghanistan who are dealing with traumatic brain injury and PTSD,” Senator Sanders said. “Are we making progress?”

“This is a tough area for us,” Mr. Shinseki replied. “We are putting $7 billion against mental health, we have a separate funding line for traumatic brain injuries and we do research in this area.”

That research, which takes place largely at five polytrauma centers run by the department across the country, would receive $580 million in direct appropriations as well as an additional $1.3 billion from the department’s medical care program under the president’s budget.

“Budgeting,” Mr. Shinseki confessed, “is a little bit reactive. We look at what showed up at our medical facilities and we ask for resources to take care of the next population. We are working with DoD (Department of Defense) to try to anticipate what our requirements are going to be, just writ-large, and trying to understand what the mental health piece of that is.”

A need for increased collaboration between the departments of Defense and Veterans Affairs is precisely what veteran advocacy groups have identified as being at the crux of the larger issue.

Alex Nicholson, Legislative Director for Iraq and Afghanistan Veterans of America, believes that many of the issues facing veterans today could be addressed more quickly through broader cooperation between government entities. “The problem is not just a V.A. problem,” explained Mr. Nicholson in a phone interview last week. “And, the fix is not just a V.A. fix.”

As the Defense Department continues reducing troop levels and the number of new veterans continues to grow, many veterans wonder if veterans affairs can significantly reduce homelessness, tame the backlog and expand mental health services.

“Frankly, we’ve been at war for over a decade and we have small professional formations, smaller than when I served, who have carried this responsibility for carrying on these two operational missions now for this long,” Mr. Shinseki said before the Senate committee. “Because of the size of the force, they are rotated a number of times, multiple times, and we compound the issues, especially in mental health.”

He added: “We owe these youngsters the best we can provide.”
Jacob W. Sotak served in the United States Army Reserve for 10 years, including a tour in Afghanistan. He graduated from Dartmouth College and now works as a news assistant at The New York Times. Follow him on Twitter: @JWSotak

For more than a year, I have been trying my hardest to move on with my life after being medically retired from the Marine Corps. I have developed compensatory strategies that allow me to succeed personally and professionally, despite having suffered a traumatic brain injury in Afghanistan more than three years ago. I haven’t just had to overcome T.B.I. since leaving the corps, though: I have also had to battle post-traumatic stress disorder, something that Luke, my service dog, has made much easier.

When I retired, I was informed that I would have annual check-ups to monitor my conditions for a total of five years. Missing these required appointments would result in losing all retirement benefits, such as pay and medical coverage for my family. So when I received military orders to confirm my appointments at Camp Lejeune, in North Carolina, I did so immediately. When I called, I was informed I had been scheduled for a neuropsychological evaluation, something I had previously had in 2012 as part of my retirement evaluation. The evaluation measures behavioral and cognitive changes resulting from central nervous system disease or injury, according to the University of North Carolina’s department of neurology.

I was less than thrilled when I got off the phone with Camp Lejeune. As part of my therapy and my new outlook on life, I choose to focus on positive things. But the results of a neuropsychological test point out all of your deficiencies by labeling you below-average or poor in certain functions of the brain. In 2012, I was depressed for two weeks following the receipt of my initial results. A medical opinion is one thing, but definitive test results can break your heart, when you think back to how you were before your injuries.

On Jan. 13, Luke and I went to my first appointment. Filling out the necessary paperwork before my appointment, I could feel my anxiety rising. My palms began to sweat and my knees began to shake. When the doctor called my name, my knees nearly buckled as I stood up. Walking back toward his office, I knew what was coming so I almost turned to walk away. But for the sake of my family I continued to his office.

Throughout our two-hour session I massaged Luke’s head to keep myself occupied and to manage my nerves. I’m sure the psychologist took note of it but I honestly didn’t care. As he flipped through my medical record, he seemed to stop at every trauma-related event noted within. He asked me about Fallujah, Iraq, and the two traumatic brain injuries I suffered there. As he continued through the pages, he stopped again and we discussed my threats of suicide in 2007 and 2011. We spoke about Afghanistan and my T.B.I. there. He asked about fallen comrades and whether any of my symptoms affected my relationships with my wife and daughter. We spoke of my suicide attempt in December 2012 and how I felt about having killed people. He even wanted to hear about the kinds of intrusive thoughts and nightmares I continued to have on a near-daily basis.

I understand that much like I had a job to do during my time in uniform, this Navy psychologist had a job to do as well, but I wondered if he noticed the tears welling in my eyes during the entire session.

I left feeling defeated and depressed, but I knew that that was just the start. Two days later I would be subjected to more than four hours of cognitive testing. A week later I would return for a debriefing of sorts and hear the results of my tests.

As I awaited the results of that evaluation, I found myself wondering whether there might be a better way to treat our combat-wounded veterans than to traumatize them every few years. There must be a more effective way to determine whether they have gotten better, or worse, than to pull them from their lives and undermine progress they may have made. I was told by my military psychiatrist in 2012 that it was her clinical opinion that I should not lead Marines into combat again, not just for my own safety but for theirs as well. I still believe that advice holds true today.

I fought for my country. I nearly died for my country. I will continue to do whatever I am told to do to maintain the benefits I rightfully deserve for the many sacrifices my family and I have made. But still, I must question the way the military machine handles its wounded service members. And after 12 years of war, there are thousands upon thousands of others out there, just like me.
Thomas James Brennan is a military affairs reporter with The Daily News in Jacksonville, N.C. Before being medically retired last December, he was a sergeant in the Marine Corps who served in Iraq and Afghanistan with the First Battalion, Eighth Marines. He is a member of the Military Order of the Purple Heart and the recipient of a 2013 Dart Center honorable mention. Follow him on Twitter.

As a parent, you spend your entire life trying to protect your children. You provide them with the very best you can; you hope they learn from your mistakes. It’s so easy when they are young and a simple “because I said so” is reason enough.

How, then, do you wrap your head around the fact that your 30-year-old, happily married son has taken his own life? After the initial shock, you review every single decision you ever made with regard to him. “If only” becomes your mantra. Then you look back at his life and remember that he was the most trusting, caring, creative and intelligent human being you’ve ever known.

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Daniel Somers at his graduation from theDefense Language Institute in Monterey, Calif., in June 2006.Credit Courtesy of Howard and Jean Somers

You want to know what went wrong.

Our son Daniel enlisted in the Army National Guard in 2003. We were proud, though a bit frightened for him, but he was reassuring and confident that it was the correct path. He went to war as a member of a Tactical Human Intelligence Team. He celebrated his 21st birthday at Fort Hood in Texas, then deployed to Iraq for 13 months.

He came home a chain smoker, a habit he had developed to “fit in” with the Iraqis with whom he interacted. He was jittery and cautious. He would tell a story or two or relate a particular incident, but he frequently said that much of his tour was classified and that he would tell us about it “in 10 years, when it’s declassified.” He expressed a desire to return to Iraq to continue helping, and he was proud when he told us that he had qualified to study Arabic at the Defense Language Institute in Monterey, Calif., a 15-month course.

In June 2006, his National Guard unit assigned him to a position with L-3 Communications, a large defense contractor, in Washington, D.C. About six months later, he told us that L-3 needed someone to go to Iraq to provide analysis, and that he had volunteered. He seemed so happy to have been given this chance to go back and help. He deployed in early 2007. We found out later that he also participated in many Special Operations missions.

Daniel returned home in the fall of 2007. In conversations over the next few months, he told us that he had made several attempts to get medical treatment for an array of health problems. Because his National Guard unit was still in ready reserve status, the Veterans Affairs Department medical center in Phoenix refused him treatment because he was not yet officially a veteran. The local Defense Department health care facility denied him services because he was not on active duty. He told us that he had suffered innumerable concussions in the course of more than 400 missions in the turret of a Humvee. He spoke of having flashbacks, and he appeared tense and nervous in person.

But for the most part, he hid the severity of his symptoms from us. When he was finally deemed eligible for veterans benefits, he began treatment at the Phoenix medical center in February 2008. There, he was diagnosed with post-traumatic stress and traumatic brain injury, and given a disability rating of 40 percent. By the end of that year, Daniel was so frustrated with the problems with his care, including long wait times for appointments and turnover in health care providers, that he sought treatment from outside providers at his own expense. From time to time he attempted to re-enter the Veterans Affairs system, only to experience the persistent problems of access and availability.

Daniel took his own life on June 10 of this year, a block and a half from his Phoenix home. He left the family a letter listing the many roadblocks to care he had encountered in the Veterans Affairs system.

We also found a cover letter he had written as part of his disability benefits claim, describing his many physical and psychological ailments. It was not until we read the letter that we truly understood the immense scale of his illnesses. He described his post-traumatic stress and traumatic brain injury symptoms in these words: “unrelenting depression and a generally joyless existence,” terrifying nightly panic attacks, and “unbearable anxiety and fear in any situation in which I don’t have complete control of the surroundings.” In addition, he wrote, he had a “constant bombardment of violent thoughts and images.”

His physical symptoms included acute and chronic pain from fibromyalgia, which was so “grinding” that at times he could barely move; chronic fatigue so severe that “just holding my head upright requires more effort that I can bear”; excruciating headaches that could “easily be enough to strike an entire day from my calendar”; and an extreme case of irritable bowel syndrome that “literally controlled my schedule.” He was so embarrassed by these medical issues that we did not know until after his death that the hugs we gave him for comfort actually hurt him physically.

After reading these letters, we, along with Daniel’s wife and mother-in-law, identified multiple systemic issues at the Veterans Affairs Department and suggested possible solutions. This report has evolved into a “white paper” in which we recommend increased access, advocacy and accountability. Our plan calls for the department’s medical centers to adopt systemwide procedures to triage and prioritize care for veterans based on the severity of their condition and suicide risk. In addition, we feel the department should refocus the mission of its medical centers to become “centers of excellence” for the care and treatment of military service injuries and conditions only. Veterans with other medical conditions would be treated by contracted providers within the community at large.

We first took our concerns to the Phoenix veterans medical center. They had reached out to us after Daniel’s death to open a dialogue about the issues Daniel had described. We were astounded and appreciative when they acknowledged serious deficiencies in their system. Then we traveled to Washington to speak to the staffs of the House and Senate Veterans Affairs Committees, and were again astounded when they shook their heads in agreement as we detailed the problems we had identified. What was most disturbing was the realization that everyone was aware of the issues, but uniformly pessimistic about effectuating any significant change within the huge Veterans Affairs bureaucracy.

Since then, we have spoken directly to multiple elected officials in California and Arizona, on both sides of the aisle. We are continuing our dialogue with the Veterans Affairs management team in Phoenix. We participated in the San Diego Veterans Affairs Mental Health Summit and were subsequently invited to attend weekly mental health meetings. We have returned to Capitol Hill and, with the dedicated support of Representatives Kyrsten Sinema and Ann Kirkpatrick, both Arizona Democrats, have met with senators and representatives from around the country. Representative Sinema convened her fellow lawmakers for a “special order hour” on the House floor to discuss military suicides, using Daniel’s story as a focal point.

We will always be Daniel’s parents, but we now feel the need, the duty and the obligation to be a loud voice for veterans who are too sick or too broken to speak for themselves. This is a completely new experience for us. We are retired medical professionals who have no prior involvement with the political process other than voting, and we have never before been strong advocates for any particular issue. However, this Veterans Day we will be marching in the Veterans Day Parade in New York City with the Iraq and Afghanistan Veterans of America, and we are honored to have been asked to carry their banner.

There is too much at stake here. Solutions cannot wait another 10 or even five years. Positive and effective changes have to happen now. We, the people, must demand that no service member or veteran suffer the wide range of fundamental deficiencies that Daniel did in services that they need and are entitled to.

On behalf of every American who, like Daniel, put on a uniform and served our country, we must do better.

If you are a veteran or survivor reading this and need help, there are places to turn. The Veterans Crisis Line (1-800-273-8255; press 1), TAPS (taps.org) and the Iraq and Afghanistan Veterans of America (iava.org) offer support and resources.

Howard and Jean Somers live in the San Diego area. Howard is a New York native who grew up in Stuyvesant Town, and attended Stuyvesant High School and New York University. He is a retired urologist who practiced in Phoenix for 26 years. Jean is a paralegal who was Howard’s practice manager. She grew up in Canton, Ohio, spent 15 years in the Washington, D.C., area, and retired after 30 years in the health care industry.

“To the woman I love with my whole heart and soul: You are finally free of the terror I have caused in your life,” I wrote. “I am sorry for everything I have done to you. I deserve every bit of sorrow I feel.”

“Never forget how much I love you and cherish the times we spent together,” my letter continued. “I’ll hopefully see you on the other side.”

Writing a suicide note to my wife on Dec. 28, 2012, was much easier than I thought it should be. I was also surprised at how easy it was to then swallow an entire bottle of sleeping pills. But lying down and accepting my fate was the easiest by far.

I stared intently at my grease-stained pair of Marine Corps-issued boots strewn across my bedroom carpet. I locked my gaze on the debossed eagle globe and anchor on the outside of each heel. I wondered if asking for help for my post-traumatic stress disorder and traumatic brain injury was the smartest decision – after all, it had ended my career.

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Thomas James Brennan with his wife, Melinda; daughter, Madison; and service dog, Luka, at Ocracoke Island in North Carolina.Credit Thomas James Brennan

The way my leaders had treated me tore me up on the inside, and their words haunted me. They had convinced me that I was not a Marine in pain, but someone looking for free benefits from the Department of Veterans Affairs. At work, at home, in bed, all I could think about was how my career in the corps had ended in such a terrible, tasteless fashion, with my peers and leaders turning their backs on me because I had enrolled in treatment.

I felt worthless.

I lay back again, closed my eyes and began to wait. Thoughts began rushing through my head. How had I gone from being a strong and supportive father to this? How had I fallen so far?

Deep down I knew the answers to my questions.

For nearly 10 years I identified myself as a Marine, but in the wake of my medical retirement in December 2012, I had no identity. Things couldn’t have been stranger for me. I had come to accept my retirement and was excited for the future. But now, two days before my retirement date, every ounce of shame, fear and sadness that I thought I should have felt during the two years I waited for my medical board to come back came rushing down upon me.

I thought about standing on the yellow footprints at Parris Island. I remembered the endless sand dunes of Kuwait and Iraq as I flew to my first deployment in 2004. I thought about the pride I felt when the commandant of the Marine Corps, Gen. James F. Amos, awarded me my Purple Heart in Afghanistan on Christmas, 2010.

Lastly, I imagined my daughter’s tears and shame years later once she found out her father quit on himself because life proved too difficult. I couldn’t be a failure in my daughter’s eyes. I couldn’t leave her to a life without me. I couldn’t have her think I was a failure.

My eyes sprang open to the thought of her crying at my flag-draped coffin. I immediately felt the stomach acid inching up the back of my throat with each crack of the 21-gun salute. As I rushed to the bathroom, my mouth began to fill with vomit. Dozens of little white pills floated atop the water. I could hear taps playing in the back of my mind.

But had I gotten them all out? Violently driving my fingers down my throat, I vomited more and more, trying to rid my body of the poison while tears rolled off my face.

I fell back onto the bathroom floor and wondered what I had just done. Staring up at the ceiling, I wanted to hear my wife and daughter’s voice. I needed to find a way to smile.

As I told my wife what I had just done, she pleaded with me to get help.

I called my psychiatrist’s office, but it was closed. Next, I called Fort Bragg, a local Army base, and after being transferred half a dozen times to various offices across the base I was told to call my local Veterans Affairs hospital since I was two days from retirement. They didn’t provide me with any numbers to call. They did, though, tell me to enjoy my weekend. The woman on the phone for the V.A. hospital in Fayetteville, N.C., was “sad to inform me” that because I was still on active duty, the Department of Veterans Affairs could not assist me. Silence ensued as I heard the phone click.

I just wanted to get my emotions off my chest.

Speeding down country roads and feeling the crisp December wind blow against my face felt nice – so nice that I don’t remember exactly how I got to the Southeastern Regional Medical Center parking lot in Lumberton, N.C. I walked toward the red letters of the hospital’s entrance. They mesmerized me as I took my last drag from my cigarette, flicked the butt to the ground and walked through the revolving doors on my way to the front desk.

For more than three hours I sat on a hard plastic chair in a dimly lit corner of an emergency room hallway wearing a drafty hospital gown, which I was forced to change into as I stood in the hallway. Letting out a sigh, I rested my elbows on my knees, laid my head in my hands and blankly stared at the wall.

I felt alone once again.

I dozed off. I don’t know how long I slept – long enough to be startled when two police officers nudged my shoulders. I was being involuntarily committed to the psychiatric ward and was given the option of being handcuffed or voluntarily following them. I chose the latter. Everyone in the emergency room seemed to stare as I walked away. On the elevator I began to cry.

The elevator door creaked open and I was ushered past a guard and told to stand next to the nurses’ station. With its inch-thick glass and solid metal doors, it looked more like something you’d find in a prison. I stood in awe at the array of people I saw there. Some wandered the hallways aimlessly, and others sat in an array of rubber chairs scattered about. With their glassy eyes, all of them looked overmedicated.

My initial interview with a nurse consisted of discussing my current medications and being warned that if I refused new medication I could be forced to comply. By the end of the first day I learned to ignore time. Bedtime came after receiving more medication than I was used to. They told me it was to help me sleep. And it did.

By the afternoon of Day 2 I still hadn’t talked to anyone about why I was there. I asked to speak to one of the nurses. I wanted to know what medications they had me on and when I would see the doctor. My head felt foggy, and thinking was far more difficult than normal. All I wanted to do was sit down or sleep.

I vaguely remember watching television and making small talk with my fellow patients. We laughed at the schizophrenics and cracked jokes about those drooling on themselves. It was a cynical way to pass the time, but it worked. Before I knew it I was lying in my bed. Two days down, two to go.

Morning came faster than expected. While I was scarfing down my chalky eggs and slurping on my decaffeinated black coffee, a nurse told me it was my turn to see the doctor.

I expected a cordial handshake or at least a hello. I got nothing. He began asking me mundane questions. Did I know why I was here? Am I still suicidal? I refused to let him get a rise out of me. He suggested changes to the psychotropic regimen. For a total of three minutes I sat in his office, and he didn’t answer a single question I asked. Silence outweighed the conversation. He motioned toward the door and told me I was being discharged the next day.

I had wasted three days – three days that convinced me I would never ask for help from someone new ever again.

Blood pressure. Lunch. Blood pressure. Dinner. Medication. Bed.

If it weren’t for the medication, I would never have fallen asleep that night. When I woke up, beside my bed were a dozen discharge papers. At the nurses’ station, I threaded my laces back into my shoes, and I couldn’t help but smile. And then, sliding my belt through the loops, I began to laugh at myself uncontrollably. The nurses looked at me awkwardly as they led me out the door and into the elevator.

Thomas James Brennan is a military affairs reporter with The Daily News in Jacksonville, N.C. Before being medically retired last December, he was a sergeant in the Marine Corps who served in Iraq and Afghanistan with the First Battalion, Eighth Marines. He is a member of the Military Order of the Purple Heart and the recipient of a 2013 Dart Center honorable mention. Follow him on Twitter.

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At War is a reported blog from Afghanistan, Pakistan, Iraq and other conflicts in the post-9/11 era. The New York Times's award-winning team provides insight — and answers questions — about combatants on the faultlines, and civilians caught in the middle.

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